New CT criteria for nodal staging in non-small cell lung cancer

Abstract

ObjectiveThe purpose of our study was to develop a simple noninvasive technique for nodal staging using routine preoperative computed tomography (CT). Materials and methodsThe institutional review board approved this retrospective study, and written informed consent to perform the initial and follow-up CT studies was obtained from all patients. Preoperative CT findings (n=218 patients with resectable non-small cell lung cancer) and pathological diagnoses after surgical resection were evaluated. Using CT images, lymph node section area, circumference, and lesion attenuation values (LAVs) were drawn freehand, and the short axis (SA) and long axis (LA) were measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze the section area, circumference, and LAVs. ResultsBased on ROC curves, two cut-off values, lymph node section area >30 mm2 and circumference >25 mm, showed greater sensitivity for nodal staging than the conventional criterion of lymph node SA ≥10 mm or the LA, SA/LA ratio or LAVs. Using lymph node section area >30 mm2 for diagnosis, the sensitivity, specificity, and accuracy of nodal staging were 90.5%, 56.3%, and 58.3%, respectively. Using lymph node circumference >25 mm, the values were 76.2%, 70.4%, and 70.8%, respectively. ConclusionLymph node section area >30 mm2 and circumference >25 mm can serve as supportive criteria used by radiologists and surgeons to determine nodal staging. If these CT criteria are met, use of a more sensitive procedure such as positron emission tomography or mediastinoscopy is recommended. Concise abstractCT is used routinely during preoperative management of lung cancer. Based on ROC analyses, the cut-off values for surface area, circumference, the SA/LA ratio, and LAVs for diagnosis of lymph node metastasis were 30 mm2, 25 mm, 0.65, and 50 Hounsfield units, respectively. Our findings indicate that lymph node surface area >30 mm2 and circumference >25 mm are supportive criteria that can be used by radiologists and thoracic surgeons to determine nodal staging and surgical indications.